Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment A Review

Dominik Linz, R. Doug Mcevoy, Martin R. Cowie, Virend Somers, Stanley Nattel, Patrick Lévy, Jonathan M. Kalman, Prashanthan Sanders

Research output: Contribution to journalReview article

40 Citations (Scopus)

Abstract

IMPORTANCE Obstructive sleep apnea (OSA) is the most common clinically significant breathing abnormality during sleep. It is highly prevalent among patients with atrial fibrillation (AF), and it promotes arrhythmogenesis and impairs treatment efficacy. OBSERVATIONS The prevalence of OSA ranges from 3%to 49%in population-based studies and from 21% to 74%in patients with AF. Diagnosis and treatment of OSA in patients with AF requires a close interdisciplinary collaboration between electrophysiologists, cardiologists, and sleep specialists. Because the prevalence of OSA is high in patients with AF and most do not report daytime sleepiness, sleep-study evaluation may be reasonable for patients being considered for rhythm control strategy. Acute, transient apnea-associated atrial electrophysiological changes and increased occurrence of AF triggers associated with short episodes of intermittent deoxygenation and reoxygenation, intrathoracic pressure changes during obstructed breathing efforts, and sympathovagal activation combine to create a stimulus for AF triggers and a complex and dynamic substrate for AF during sleep. Repeated episodes of long-term OSA are eventually associated with structural remodeling and changes in electrical conduction in the atrium. Observational data suggest OSA reduces the efficacy of catheter-based and pharmacological antiarrhythmic therapy. Nonrandomized studies have shown that treatment of OSA by continuous positive airway pressure can help to maintain a sinus rhythm after electrical cardioversion and catheter ablation in patients with AF. However, it remains unclear which sleep apnea metric should be used to determine severity and guide such treatment in patients with AF. CONCLUSIONS AND RELEVANCE Data from nonrandomized studies of patients with AF suggest that treatment of OSA by continuous positive airway pressure may help to maintain sinus rhythm after electrical cardioversion and improve catheter ablation success rates. Randomized clinical trials are needed to confirm the association between OSA and AF the benefits of treatment of OSA and the need for and cost-effectiveness of routine OSA screening and treatment.

Original languageEnglish (US)
Pages (from-to)532-540
Number of pages9
JournalJAMA Cardiology
Volume3
Issue number6
DOIs
StatePublished - Jun 1 2018

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Continuous Positive Airway Pressure
Obstructive Sleep Apnea
Atrial Fibrillation
Sleep
Therapeutics
Electric Countershock
Catheter Ablation
Respiration
Sleep Apnea Syndromes
Apnea
Cost-Benefit Analysis
Catheters
Randomized Controlled Trials
Pharmacology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment A Review. / Linz, Dominik; Mcevoy, R. Doug; Cowie, Martin R.; Somers, Virend; Nattel, Stanley; Lévy, Patrick; Kalman, Jonathan M.; Sanders, Prashanthan.

In: JAMA Cardiology, Vol. 3, No. 6, 01.06.2018, p. 532-540.

Research output: Contribution to journalReview article

Linz, Dominik ; Mcevoy, R. Doug ; Cowie, Martin R. ; Somers, Virend ; Nattel, Stanley ; Lévy, Patrick ; Kalman, Jonathan M. ; Sanders, Prashanthan. / Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment A Review. In: JAMA Cardiology. 2018 ; Vol. 3, No. 6. pp. 532-540.
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